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Yes |
No |
| 1. |
Does someone in your family
undergo personality changes when he/she drinks to excess? |
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| 2. |
Do you find yourself bewildered
by what’s happening in your life? |
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| 3. |
Do you feel that drink is
more important to this person than you are? |
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| 4. |
Do you feel sorry for yourself
and frequently indulge in self-pity? |
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| 5. |
Has excessive drinking ruined
special occasions? |
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| 6. |
Do you find yourself covering
up for the consequences of someone else's drinking? |
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| 7. |
Do you often feel guilty
or apologetic? |
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| 8. |
Is drinking involved in
many of your family activities? |
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| 9. |
Do you feel that you’re
different from other people? |
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| 10. |
Have you ever tried to fight
the drinker by joining in the drinking? |
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| 11. |
Do you often feel depressed? |
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| 12. |
Is your family having financial
difficulties because of your drinking? |
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| 13. |
Do you have an unhappy home
life? |
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| 14. |
Have you ever tried to control
the drinker’s behavior by hiding the car keys, pouring the liquor
down the drain, etc.? |
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| 15. |
Do you find yourself doing
things out of character? |
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| 16. |
Do you find yourself distracted
from your responsibilities because of this person’s drinking? |
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| 17. |
Do you find yourself responding
inconsistently to other members of your family? |
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| 18. |
Have you ever been embarrassed
or felt the need to apologize for the for the drinker’s actions? |
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| 19. |
Do you no longer feel good
about yourself? |
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| 20. |
Have you ever feared for
your own safety or the safety of other members of your family? |
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